EFFECT OF TRIMETHOPRIM-SULFAMETHOXAZOLE PROPHYLAXIS ON FEACAL CARRIAGE RATES OF RESISTANT ISOLATES OF ESCHERICHIA COLI IN HIV-INFECTED ADULT PATIENTS IN LAGOS.

Background: The daily use of Trimethoprim-Sulfamethoxazole (TMP-SMX) prophylaxis reduces morbidity and mortality among patients infected with human immunodeficiency virus (HIV) but its impact on increasing antimicrobial resistance rates has been of public health concern, globally. This study investigated the effect of daily TMP-SMX prophylaxis on feacal carriage rates of resistant isolates of Escherichia coli in HIV-infected adult patients in Lagos. Methods: A total of 550 HIV-infected patients with CD4-cell counts of less than 350 cells/mm3 who were eligible for TMP-SMX prophylaxis and attending Lagos University Teaching Hospital, Lagos, Nigeria, were recruited for this study. Stool/rectal swab samples were aseptically collected from the patients and processed using standard methods for culture and sensitivity. Results: There was a baseline Trimethoprim-Sulfamethoxazole resistance rate of 54% which increased to 77.9% in first 3 months, rising to 96.1% by 6 months and all isolates were resistant by the 9th month. There was also evidence of cross-resistance to other antibiotics with significance in association with TMP-SMX resistance (

EFFECT OF TRIMETHOPRIM-SULFAMETHOXAZOLE PROPHYLAXIS ON FAECAL CARRIAGE RATES OF RESISTANT ISOLATES OF ESCHERICHIA COLI IN HIV-INFECTED ADULT PATIENTS IN LAGOS.

Background: The daily use of Trimethoprim-Sulfamethoxazole (TMP-SMX) prophylaxis reduces morbidity and mortality among patients infected with Human Immunodeficiency Virus (HIV) but its impact on increasing antimicrobial resistance rates has been of public concern globally. This study investigated the effect of daily TMP-SMX prophylaxis on faecal carriage rates of resistant isolates of Escherichia coli in HIV-infected adult patients in Lagos. Methods: A total of 550 HIV-infected patients with CD4-cell count of less than 350 cell/mm3 and were eligible for TMP-SMX prophylaxis attending Lagos University Teaching Hospital, Lagos, Nigeria, were recruited. Stool/rectal swab samples were aseptically collected from the patients and processed using standard methods for culture and sensitivity. Results: There was a baseline Trimethoprim-Sulfamethoxazole resistance rate of 54% which increased to 77.9% in first 3 months, rising to 96.1% by 6 months and all isolates were resistant by the 9th month. There was also evidence of crossresistance to other antibiotics with significant association with TMP-SMX resistance (

Technology for the prevention of antimicrobial resistance and healthcare-associated infections; 2017 Geneva IPC-Think Tank (Part 2).

Background: The high burden of healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) is partially due to excessive antimicrobial use both in human and animal medicine worldwide. How can technology help to overcome challenges in infection prevention and control (IPC) and to prevent HAI and emerging AMR? Methods: In June 2017, 42 international experts convened in Geneva, Switzerland to discuss four potential domains of technology in IPC and AMR: 1) role and potential contribution of microbiome research; 2) whole genome sequencing; 3) effectiveness and benefit of antimicrobial environmental surfaces; and 4) future research in hand hygiene. Results: Research on the microbiome could expand understanding of antimicrobial use and also the role of probiotics or even faecal transplantation for therapeutic purposes. Whole genome sequencing will provide new insights in modes of transmission of infectious diseases. Although it is a powerful tool for public health epidemiology, some challenges with interpretation and costs still need to be addressed. The effectiveness and cost-effectiveness of antimicrobially coated or treated environmental high-touch surfaces requires further research before they can be recommended for routine use. Hand hygiene implementation can be advanced, where technological enhancement of surveillance, technique and compliance are coupled with reminders for healthcare professionals. Conclusions: The four domains of technological innovation contribute to the prevention of HAI and AMR at different levels. Microbiome research may offer innovative concepts for future prevention, whole genome sequencing could detect new modes of transmission and become an additional tool for effective public health epidemiology, antimicrobial surfaces might help to decrease the environment as source of transmission but continue to raise more questions than answers, and technological innovation may have a role in improving surveillance approaches and supporting best practice in hand hygiene

Broadening the infection prevention and control network globally; 2017 Geneva IPC-think tank (part 3).

Background: Healthcare-associated infection (HAI) is a major challenge for patient safety worldwide, and is further complicated by antimicrobial resistance (AMR) due to excessive antimicrobial use in both humans and animals. Existing infection prevention and control (IPC) networks must be strengthened and adapted to better address the global challenges presented by emerging AMR. Methods: In June 2017, 42 international experts convened in Geneva, Switzerland, to discuss two key areas for strengthening the global IPC network: 1) broadening collaboration in IPC; and 2) how to bring the fields IPC and AMR control together. Results: The US Centers for Disease Prevention and Control, the European Centre for Disease Prevention and Control, and the World Health Organization (WHO) convened together with international experts to discuss collaboration and networks, demonstrating the participating organizations' commitment to close collaboration in IPC. The challenge of emerging AMR can only be addressed by strengthening this collaboration across international organisations and between public health and academia. The WHO SAVE LIVES: Clean Your Hands initiative is an example of a successful collaboration between multiple global stakeholders including academia and international public health organisations; it can be used as a model. IPC-strategies are included within the four pillars to combat AMR: surveillance, IPC, antimicrobial and diagnostic stewardship, research and development. The prevention of transmission of multidrug-resistant microorganisms is a patient safety issue, and must be strengthened in the fight against AMR. Conclusions: The working group determined that international organisations should take the lead in creating new networks, which will in turn attract academia and other stakeholders to join. At the same time, they should invest in bringing existing IPC and AMR networks under one umbrella. Transmission of multidrug-resistant microorganisms in hospitals and in the community threatens the success of antimicrobial stewardship programmes, and thus, research and development in IPC should be addressed as an enhanced global priority

Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action

Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or “golden rules,” for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice

An assessment of existing common traditional methods of water purification

Classical water purification methods include boiling, filtration, irradiation and the use of chemicals while traditional water purification methods in use are boiling, filtration, sedimentation, long storage and solar radiation. Waterborne diseases are m ore common in the rural communities where potable water supply coverage is usually low. Therefore, this study was designed to assess and modify existing water purification methods in use in the rural communities so as to encourage their regular use. Water samples collected from various sources serving six rural communities in Agege, Epe and Ikorodu Local Government areas of Lagos State were purified using each of the traditional methods. Viable counts were carried out on each of the water samples before and after the purification process. Water samples contamination with known pathogens were also included in the test. The boiling method was the most efficient giving 100% decontamination after three minutes of continuous boiling. The solar method gave varying degrees of decontamination of the water samples (42-100%) depending on the turbidity of the water and the type of container used for the test. The long storage method and the cloth filtration methods decontaminated the water by (0.6-4.2%) and 41% respectively. The solar water purification method should be encouraged. Turbid water samples should be cloth filtered prior to exposure to the sun for maximum efficiency. (Af. J. of Clinical and Experimental Microbiology: 2002 3(1): 41-44

Prevalence of Cryptosporidium Species in Patients with Human Immunodeficiency Syndrome (AIDS) Presenting with Diarrhoea in Lagos

Cryptosporidium is said to cause diarrhoea in HIV / AIDS patients. The study was done to determine the prevalence of cryptosporidiosis in Lagos. Stool samples were collected from 193 HIV positive and 200 HIV negative (control) patients presenting with diarrhoea at LUTH. The patient or a close relative filled a questionnaire covering demographic and other relevant information. Fresh stool specimens were processed using direct stool smear and formol-ether concentration methods. Permanently stained slides were prepared by Kinyoun acid-fast stain. Cryptosporidium was found in 36 (18.7%) of HIV positive patients and none in the control. More males than females were affected, 26 (24.8%) of 105 males as against 10 (11.8%) of 87 females. Isolation rates were highest in patients with CD4+ lymphocyte counts of 201-250 cells/ml, falling to zero in patients with CD4+ counts above 351cells/ml. Cryptosporidium is a relatively common cause of diarrhoea in HIV/AIDS patients. Keywords: Cryptosporidium, Prevalence, HIV/AIDS.NQJHM Vol. 16 (2) 2006: pp. 49-5

Characterization of non-fermenting Gram-negative Bacilli at the Lagos University Teaching Hospital - A Preliminary report

No Abstract. NQJHM Vol. 6 (3) 1996: pp. 178-18

Toxicidad fumigante para Callosobruchus maculatus (Fabricius) (Coleoptera: Bruchidae) de bulbos trozados de especies Allium.

Fumigant toxicity of crushed fresh bulbs of Allium sativum L. and A. cepa L. to the Callosobruchus maculatus (Fabricius), a major pest of stored cowpea (Vigna unguiculata (L.) Walp.) seeds was assessed under laboratory conditions in Akure, Nigeria. In the tests, 20 g of infested cowpea seeds were suspended in a piece of muslin cloth, over an amount of crushed bulb in a container with a tightly fitted lid. Adult emergence was completely prevented from freshly laid eggs of C. maculatus on cowpea seeds that was fumigated with 6.0 g or more of crushed bulbs of A. sativum. Such fumigated seeds were not holed at all. Other amounts of A. sativum tested (1.0, 2.0, 3.0, 4.0 and 5.0 g) significantly reduced C. maculatus adult emergence from fumigated eggs and seed holing in comparison with the control. Crushed A. sativum was ineffective in preventing adult emergence from fumigated C. maculatus larvae in seeds. The fumigant effect of crushed A. cepa did not kill all C. maculatus eggs. An amount of 7.0 g significantly reduced C. maculatus adult emergence from fumigated eggs and seed holing in comparison with the control. There is good prospect in using crushed bulbs of A. sativum as fumigant in C. maculatus control in stored cowpea seeds.Se evaluó la toxicidad fumigante de bulbos frescos trozados de Allium sativum L. y A. cepa L. sobre Callosobruchus maculatus (Fabricius), una importante plaga de semilla almacenada de caupí Vigna unguiculata (L.) Walp. bajo condiciones de laboratorio en Akure, Nigeria. En las pruebas, 20 g de semillas infestadas se suspendieron en un trozo de tela sobre cierta cantidad de bulbos trozados en un contenedor con una tapa ajustada. Se previno completamente la emergencia de adultos desde huevos recién puestos de C. maculatus en semillas de caupí que se fumigaron con 6,0 g o más de bulbos de A. sativum. Estas semillas fumigadas no estaban ahuecadas. Otras cantidades de A. sativum probadas (1.0, 2.0, 3.0, 4.0 y 5.0 g) redujeron significativamente la emergencia de adultos de C. maculatus desde huevos fumigados y el perforamiento de la semilla en comparación con el control. A. sativum trozado fue inefectivo en la prevención de emergencia de adultos desde larvas fumigadas de C. maculatus en semillas. El efecto fumigante A. cepa trozada no mató los huevos de C. maculatus. Una cantidad de 7,0 g redujo significativamente la emergencia de C. maculatus adultos desde huevos fumigados y el perforamiento de semilla en comparación con el control. Los bulbos trozados de A. sativum se presentan como una buena alternativa como fumigante en el control de C. maculatus en semillas almacenadas de caupí

Extended Spectrum β-Lactamase (ESBL) in Klebsiella Pneumoniae Isolates from Septicaemic Children in Ibadan, Nigeria

Blood culture was performed on 204 children (aged 1 day – 12 years) who presented at the University College Hospital (UCH) Ibadan, Nigeria, with fever. Eighty-four (41.3%) out of 204 blood cultures were positive. Staphylococcus aureus was the commonest bacterial agent isolated and accounted for (50%) of all the isolates. Klebsiella spp and Salmonella spp each accounted for 21.4% and 10.7% respectively. Other bacterial agents isolated included Escherichia coli, Enterobacter spp. Citrobacter spp. Pseudomonas aeruginosa, Streptococcus Pneumoniae and Serratia spp. Two of the children died in spite of early use of appropriate antibiotics as determined by antibiotic susceptibility testing. Phenotypic and molecualr investigation showed extended-spectrum β-lactamase (ESBL) producing K. pneumoniae to be implicated in the death of the children. Several other K. pneumoniae isolates recovered from blood samples expressed ESBLs and the isolates were shown by pulsed field gel electrophoresis of chromosomal DNA to be genetically unrelated. KEY WORDS: Klebsiella pneumoniae, septicaemic, ESBL. Nigerian Journal of Health and Biomedical Sciences Vol.3(2) 2004: 79-8